MEDICARE: SUNG LYDON D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223G0001X	General Practice Dentistry	48504	CA

General Provider Information

NPI Number	:	1447421912
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUNG LYDON D.D.S.

Provider Business Mailing Address
First Line	:	4250 SCOTT DR
Second Line	:	SUITE J
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-1932
Country	:	US
Telephone Number	:	949-660-1321
Fax Number	:	949-851-0856

Provider Business Practice Location Address
First Line	:	4250 SCOTT DR
Second Line	:	SUITE J
City	:	NEWPORT BEACH
State	:	CA
Zip	:	92660-1932
Country	:	US
Telephone Number	:	949-660-1321
Fax Number	:	949-851-0856

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/12/2008
Last Update Date	:	03/12/2008

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